Individual
MADELINE MILLARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2711 ZACHARY LAKE DR SW, MARIETTA, GA 30064-1882
(770) 330-1651
Mailing address
2711 ZACHARY LAKE DR SW, MARIETTA, GA 30064-1882
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
—
—
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
02/03/2018
Last updated
02/03/2018
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